The objective of this proposed project is to demonstrate the improvement of drug use in nursing homes and its effect on certain patient outcomes and variables through drug use review (DUR) feedback mechanisms and educational programs designed for physicians, nurses, and patients. To accomplish this, criteria will be developed for appropriate geriatric prescribing of a select group of drugs; and protocols will be developed for appropriate patient use of these drugs. With the aid of a computerized DUR system which will be refined, problems with appropriateness of drug prescribing and use will be identified. Then through mechanisms of DUR feedback for physicians, and education of some physicians, nurses and patients, as specified in the study design, any improvements in drug prescribing or use associated with the program will be delineated. The effects of appropriate and inappropriate drug prescribing and use on patient outcome measures will be recorded. Costs of the DUR feedback study and the patient, nurse, and physician education project will be documented. Finally, these program costs will be related to observed effects of appropriate and inappropriate prescribing and use on patient outcome measures.